The Deadly Choices at Memorial

Published: August 25, 2009

Soon after sunrise on Thursday, Sept. 1 — more than 72 hours into the crisis — Memorial’s chief financial officer, Curtis Dosch, delivered good news to hospital staff gathered on the emergency-room ramp. He had reached a Tenet representative in Dallas and was told that Tenet was dispatching a fleet of privately hired helicopters that day. Dosch later said that the dejected staff was skeptical. But soon the hospital’s voice chain began echoing with shouts for women and children to evacuate. Boats were arriving, including fishing vessels that had been parked on trailers in the neighborhood and were now commandeered by hospital workers. Helicopters at last converged on the hospital within a couple of hours of daylight, according to a Memorial nurse from the Air Force Reserve who oversaw helipad operations. The Tenet spokesman and testimony by Mulderick in a 2008 deposition also confirm this. The hospital filled with the cacophony of military and private crafts hovering and landing. Down on the emergency-room ramp that morning, stone-faced State Police officers wielding shotguns barked that everyone had to be out of the hospital by 5 p.m. because of civil unrest in New Orleans; they would not stay later to protect the hospital.

This article is a collaboration between ProPublica and The New York Times.

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Meanwhile, Cook strapped on his gun again and prepared to leave the hospital by boat to rescue his son, who had been trapped at his house since Tuesday’s flooding. He told me that Mulderick asked him before he left to talk to Pou.

On the second floor, Cook says, he and Pou, both weary, discussed the Category 3 patients, including nine who had never been brought down from the seventh floor. According to Cook, Pou was worried that they wouldn’t be able to get them out. Cook hadn’t been on the seventh floor since Katrina struck, but he told me that he thought LifeCare patients were “chronically deathbound” at the best of times and would have been horribly affected by the heat. Cook couldn’t imagine how the exhausted Memorial staff would carry nine patients down five flights of stairs before the end of the day. Nobody from outside had arrived to help with that task. If there were other ways to evacuate these patients, he didn’t see them.

Cook said he told Pou how to administer a combination of morphine and a benzodiazepine sedative. The effect, he told me, was that patients would “go to sleep and die.” He explained that it “cuts down your respiration so you gradually stop breathing and go out.” He said he believed that Pou understood that he was telling her how to achieve this. He said that he viewed it as a way to ease the patients out of a terrible situation.

In an interview with Newsweek in 2007, Pou acknowledged that after discussions with other doctors, she did inject some Category 3 patients. But she said her intention was only to “help the patients that were having pain and sedate the patients who were anxious” because “we knew they were going to be there another day, that they would go through at least another day of hell.” Beyond that, Pou has not talked about the details of what happened on that Thursday, citing the pending legal cases and sensitivity to patients and their families. What follows is based on the recollections of others, some of which were recounted in interviews with Louisiana Justice Department investigators, as well as in interviews with me.

Therese Mendez, a LifeCare nurse executive, had worked overnight on the first floor, she later told investigators. (She declined to speak with me.) After daybreak, she heard the sound of helicopters and watched the evacuation line begin to move. According to Mendez, she returned at around 8 or 9 a.m. to the seventh floor and walked along a corridor. The patients she saw looked bad. Several were unconscious, frothing at the mouth and breathing in an irregular way that often heralds death. Still, while two patients died on the LifeCare’s seventh floor on Wednesday, the others had lived through the night, with only a few given small doses of morphine or the sedative lorazepam for comfort.

Mendez heard that Pou was looking for her. They sat down in an office with an open window. Pou looked distraught and told her that the LifeCare patients probably were not going to survive. Mendez told investigators that she responded, “I think you’re right.”

Mendez said she watched Pou struggle with what she was saying, telling investigators that Pou told her that “the decision had been made to administer lethal doses” of morphine and other drugs. (Pou, through her lawyer, Richard Simmons Jr., denied mentioning “lethal doses.”) Were the LifeCare patients being singled out? Mendez asked. She knew there were other sick patients at Memorial. Mendez recalled that Pou said “no” and that there was “no telling how far” it would go.

Sheri Fink, an M.D., is a staff reporter at ProPublica, the independent nonprofit investigative organization. She is the author of “War Hospital: A True Story of Surgery and Survival” and is a senior fellow at the Harvard Humanitarian Initiative.

A version of this article appeared in print on August 30, 2009, on page MM28 of the Sunday Magazine.